Pregnancy + OB + Hospital = Harmony.

Denise Bolds, MSW CD(DONA

January 9, 2017

Here’s A Scenario: A pregnant woman is faithful to her obstetrician care she currently receives. This mother-to-be has an awesome relationship with her prenatal provider: the medical professional is aligned with this woman’s beliefs and approaches to birth. The obstetrician recommends the prenatal woman to take a tour of the local hospital labor and delivery unit where the obstetrician has privileges; the mother-to-be will give birth at this facility. After taking the tour of the labor and delivery unit, the pregnant woman is distraught; she cries all the way home in her car. The hospital tour she just participated in is the complete anthesis of her obstetrician’s care and service. The pregnant woman also finds out after doing research the hospital the obstetrician has privileges in is not baby friendly; it also has a high cesarean-section rate. The pregnant woman is now faced with a dilemma; she’s 27 weeks into her pregnancy; she must accept her current provider and facility or start over with a new provider and facility as well as building a relationship from scratch. She goes to her obstetrician’s office and requests her medical records to be sent to a new provider… The current obstetrician only sends appointment dates. The pregnant woman calls her doula for guidance on how to navigate this scenario efficiently and correctly. As a certified birth doula, I have several of my clients face this very same issue every year. It is immediately assumed that if the OB provider works well, the hospital will fall in the same line as well. This is a huge fallacy and a stressor for pregnant women. 

Can Get There From Here… 

Every woman who becomes pregnant has choices. It is the diligence that is often neglected. The obstetrician maybe completely likable and even wonderful; however, the institution where he/she has privileges to deliver at is also vital. What does privilege mean? Medical practitioners have to be approved by a hospital before treating patients there: there is a credentialing check that takes place as well as malpractice coverage, and of course insurances accepted. It is a lengthy process. In the sanity of business, obstetricians usually support births at a local hospital where they provide prenatal care. It’s like an accord (agreement/understanding) between medical groups and practitioners not to encroach upon one another. It is territorial; most times the doctor has no say or influence in the hospital they attend births at. 

Baby friendly is a designation a hospital’s labor and delivery unit applies for: it is a lengthy process that involves policy change and training of staff. A baby friendly hospital supports rooming-in of mother and baby, no formula, breastfeeding support and the labor policies allows the laboring mother more flexibility. It is imperative the mother-to-be is aware of the polices and practices of both the prenatal provider as well as the institution she will birth at; same approach applies for midwives who support births at hospitals. If the pregnant woman utilizes an OB/GYN group for her prenatal care, there is a strong possibility she will not have her OB she likes when she goes into labor as the OB staff does take call on rotation. Keep in mind having a c-section is major abdominal surgery with increased risks, interventions and recovery than a natural vaginal birth with little interventions. A birth doula who is skilled can provide education support in this area as the pregnant woman makes her decisions with her partner. Having a birth preference is also a tool of empowerment. (more on that in another blog)

Know Your Rights! 

A patient has the right to change providers. A patient has the right to request their medical records and have access to them. All that is required is a signed release giving the office permission to release records and it is up to the pregnant woman to collaborate the prenatal care team she wants. It takes some diligence… Always know the cesarean section rate of any hospital and practitioner. There are several ways to research this on the internet: 

Do take the time to research c-section rates. Also, make sure you contact your insurance provider to inform them of your change in prenatal providers. You do have the right to make that change. No pregnant woman should have to face giving birth with a provider or facility that they are uncomfortable with or uncertain of. This stress will have an impact on the woman’s labor and birth.

Building A Supportive Team. A supportive team for the pregnant woman is more vital than her birth registry and the size of her baby shower combined. Having a birth doula that supports and understands the pregnant woman and her partner’s beliefs and wishes is also part of the team. The doula also has resources and considerations that the parents-to-be may not have ever considered. It is also vital to have your prenatal practitioner and institution where the birth will take place also be a part of the team. Having a supportive team positively impacts the birth and bonding of the baby and parents. It also provides respect for the doula to provide education and resources while respecting the policies of birth professionals/institution. The pregnant woman is never to feel trapped and voiceless. There’s nothing more beautiful than witnessing a pregnant woman’s confidence in her birth.